Free DOH practice questions

Correct answer: C

• A. Proceed immediately to endotracheal intubation and mechanical ventilation

  Immediate intubation is reserved for impending or actual respiratory failure, such as exhaustion, altered consciousness, silent chest, or refractory hypoxemia; these findings are not present here.

• B. Give inhaled salbutamol alone and defer corticosteroids until the peak flow normalizes

  Inhaled salbutamol is necessary, but delaying systemic corticosteroids in a substantial exacerbation increases the risk of persistent or recurrent deterioration.

• C. Give oxygen, repeated inhaled salbutamol plus ipratropium, and systemic corticosteroids

  This is the recommended initial treatment for a significant acute asthma exacerbation, with oxygen titrated to 93–95% in adults, repeated rapid-acting bronchodilators, and early systemic corticosteroids.

• D. Give intravenous antibiotics, nebulized saline, and observe for clinical improvement

  There is no evidence of bacterial pneumonia or another infection, and antibiotics do not treat the airway obstruction of an acute asthma exacerbation.

Global Initiative for Asthma (GINA), Global Strategy for Asthma Management and Prevention, 2025 · Management of asthma exacerbations in acute care (checked 9 August 2026)

Correct answer: C

• A. Arrange an urgent exercise stress test before deciding on treatment

  Exercise stress testing is contraindicated during an acute STEMI and would dangerously delay definitive reperfusion treatment.

• B. Administer fibrinolytic therapy as the initial reperfusion strategy

  Fibrinolysis is considered when timely primary PCI cannot be performed. In this case, the hospital can provide PCI within the recommended time window, so primary PCI is preferred.

• C. Activate the catheterization laboratory for immediate primary percutaneous coronary intervention

  This patient has an acute anterior ST-segment elevation myocardial infarction, and primary PCI is the preferred reperfusion strategy when it can be performed promptly by an experienced team.

• D. Repeat the ECG and cardiac troponin measurement after three hours

  Serial testing is appropriate when the diagnosis of acute coronary syndrome is uncertain. However, diagnostic ECG findings of STEMI require immediate reperfusion and should not be delayed for biomarker confirmation.

2023 ESC Guidelines for the Management of Acute Coronary Syndromes · Section 6.2.1, Primary PCI versus fibrinolysis (checked 9 August 2026)

Correct answer: D

• A. Normal glucose regulation

  This is incorrect because normal fasting plasma glucose is below 100 mg/dL (5.6 mmol/L). Two separate results above 126 mg/dL meet the biochemical criteria for diabetes.

• B. Type 1 diabetes mellitus

  This is incorrect because the presentation is more consistent with type 2 diabetes: the patient is an adult with central obesity and hypertension, and there is no acute catabolic illness, ketosis, or suggestive history of autoimmune diabetes.

• C. Prediabetes

  This is incorrect because prediabetes is diagnosed when fasting plasma glucose is 100–125 mg/dL (5.6–6.9 mmol/L). Both documented fasting values are within the diabetic range.

• D. Type 2 diabetes mellitus

  This is correct. In an asymptomatic patient, two fasting plasma glucose values of at least 126 mg/dL (7.0 mmol/L) on separate days establish diabetes. The adult age, central obesity, hypertension, and absence of ketosis or catabolic symptoms make type 2 diabetes mellitus most likely.

American Diabetes Association, Standards of Care in Diabetes—2026 · Section 2, Diagnosis and Classification of Diabetes: Criteria for the Diagnosis of Diabetes (checked 9 August 2026)

Correct answer: B

• A. Repeat transvaginal ultrasonography in 3 months

  Repeat imaging is not the appropriate initial management when postmenopausal bleeding is associated with an endometrial thickness of 8 mm; histological assessment is required.

• B. Perform an office endometrial biopsy

  This is the most appropriate next step. Postmenopausal bleeding with an endometrial thickness greater than 4 mm requires endometrial sampling, and an office biopsy is an appropriate initial method.

• C. Reassure her and arrange routine follow-up

  This is inappropriate because postmenopausal bleeding requires evaluation, and an endometrial thickness greater than 4 mm warrants endometrial tissue sampling to exclude endometrial malignancy.

• D. Proceed directly to hysteroscopy with dilation and curettage

  Hysteroscopy with dilation and curettage may be indicated when an office biopsy is inadequate, nondiagnostic, or when bleeding persists despite a benign result; it is not required as the first step in this presentation.

American College of Obstetricians and Gynecologists, Committee Opinion No. 734: The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding · Evaluation of postmenopausal bleeding; reaffirmed 2023 (checked 9 August 2026)

Correct answer: C

• A. Administer corticosteroids and delay delivery for 48 hours

  Antenatal corticosteroids may be considered when preterm delivery is anticipated, but they should not delay delivery when severe maternal disease requires urgent intervention. Maternal stabilization and delivery take priority.

• B. Start oral antihypertensive therapy and reassess in the antenatal clinic tomorrow

  Severe persistent hypertension with headache, visual symptoms, proteinuria, and elevated liver enzymes requires hospital-based urgent management, not outpatient follow-up.

• C. Stabilize the mother with magnesium sulfate and urgent antihypertensive treatment, then deliver

  This patient has preeclampsia with severe features at 34 weeks or more, with persistent severe hypertension and neurological symptoms. Maternal stabilization, seizure prophylaxis, urgent blood-pressure control, and delivery are indicated.

• D. Continue expectant management until 37 weeks with close outpatient monitoring

  Expectant management is not appropriate when severe features are present at or beyond 34 weeks, particularly with persistent severe hypertension and visual or neurological symptoms.

American College of Obstetricians and Gynecologists, Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia · Management of preeclampsia with severe features at or beyond 34 0/7 weeks of gestation, 2020 (checked 9 August 2026)

Correct answer: B

• A. Start intravenous oxytocin infusion

  Oxytocin is used to induce or augment labor when indicated, but it is inappropriate before determining the cause of painless antepartum bleeding and excluding placenta previa.

• B. Perform transvaginal ultrasonography

  This is the most appropriate next step in a stable patient with painless third-trimester bleeding because it accurately assesses placental location and is safe when placenta previa is suspected.

• C. Perform a digital vaginal examination

  This should be avoided until placenta previa has been excluded because digital examination may provoke severe hemorrhage if the placenta overlies the cervical os.

• D. Administer intramuscular methylergometrine

  Methylergometrine is a uterotonic used mainly for postpartum hemorrhage due to uterine atony; it has no role in the initial evaluation of stable antepartum bleeding.

Royal College of Obstetricians and Gynaecologists, Green-top Guideline No. 27a: Placenta Praevia and Placenta Accreta: Diagnosis and Management, 2018 · Diagnosis of placenta praevia and recommended imaging (checked 9 August 2026)

Correct answer: D

• A. Begin coordinated chest compressions

  Chest compressions are indicated when the heart rate remains below 60 beats/min despite at least 30 seconds of effective positive-pressure ventilation, not when the heart rate is 80 beats/min.

• B. Administer intravenous epinephrine

  Epinephrine is considered only if the heart rate remains below 60 beats/min despite effective ventilation and chest compressions. It is not the next step in this newborn.

• C. Apply continuous positive airway pressure alone

  Continuous positive airway pressure is appropriate for a spontaneously breathing newborn with respiratory distress or persistent cyanosis. It does not provide adequate support for an apneic newborn.

• D. Continue positive-pressure ventilation and reassess the heart rate

  This is correct. A newborn with apnea and a heart rate below 100 beats/min requires positive-pressure ventilation. If the heart rate is 60–99 beats/min after effective ventilation, ventilation should be continued with repeated assessment.

Textbook of Neonatal Resuscitation, 8th edition, American Academy of Pediatrics and American Heart Association, 2021 · Section 6: Positive-Pressure Ventilation (checked 9 August 2026)

Correct answer: C

• A. Start chest compressions immediately

  Chest compressions are indicated only if the heart rate remains below 60 beats/minute after at least 30 seconds of effective positive-pressure ventilation, not as the initial intervention here.

• B. Continue observation and provide routine newborn care

  Observation alone is inappropriate because persistent apnea and a heart rate of 80 beats/minute indicate inadequate transition and require prompt positive-pressure ventilation.

• C. Begin positive-pressure ventilation with room air

  This is correct because apnea or a heart rate below 100 beats/minute after the initial steps is an indication for positive-pressure ventilation. For a term infant, ventilation can begin with room air.

• D. Give free-flow oxygen without assisted ventilation

  Free-flow oxygen does not provide ventilation for an apneic infant. Assisted positive-pressure ventilation is required because the infant is not breathing and has a heart rate below 100 beats/minute.

Neonatal Resuscitation Program, 8th edition, American Academy of Pediatrics and American Heart Association · Chapter 5: Positive-Pressure Ventilation (checked 9 August 2026)

Correct answer: B

• A. Emergency pericardiocentesis for presumed cardiac tamponade

  Tension pneumothorax can produce hypotension and distended neck veins, but unilateral hyperresonance, absent breath sounds, and tracheal deviation identify the thoracic cause rather than tamponade.

• B. Immediate needle decompression followed by tube thoracostomy

  This is a tension pneumothorax causing obstructive shock. It is a clinical diagnosis requiring immediate decompression without waiting for chest radiography, followed by definitive tube thoracostomy.

• C. Portable chest radiography before pleural decompression

  Imaging may confirm a stable pneumothorax, but delaying decompression in a patient with clinical tension pneumothorax and shock can be fatal.

• D. Endotracheal intubation before treating the thoracic pressure

  Although airway support may eventually be required, positive-pressure ventilation before decompression can worsen intrathoracic pressure and cardiovascular compromise.

Advanced Trauma Life Support (ATLS), 11th Edition, American College of Surgeons, 2025 · Thoracic Trauma: Tension Pneumothorax (checked 9 August 2026)

Correct answer: C

• A. Total hip arthroplasty

  Total hip arthroplasty is considered for patients who were independently mobile outdoors, have no major comorbidity limiting the procedure, and are expected to remain independently mobile for more than 2 years. Those criteria are not present here.

• B. Prolonged skeletal traction without surgery

  Nonoperative traction does not provide appropriate definitive treatment for a displaced intracapsular femoral-neck fracture and is associated with complications of prolonged immobilisation.

• C. Hemiarthroplasty of the hip

  This is the preferred replacement procedure for an older patient with a displaced intracapsular femoral-neck fracture who has limited pre-fracture mobility and does not meet the usual criteria for total hip replacement.

• D. Internal fixation with cannulated screws

  Internal fixation is generally used for undisplaced intracapsular fractures or selected younger patients. In an older patient with a displaced fracture, it has a higher risk of nonunion and avascular necrosis than arthroplasty.

NICE guideline CG124: Hip fracture management · Recommendations 1.6.1–1.6.3, Arthroplasty — 1.6.1 (checked 9 August 2026)